VA Medical Center, Syracuse, NY, USA.
Am J Med. 2012 Dec;125(12):1222-7. doi: 10.1016/j.amjmed.2012.05.030.
Aspirin, by virtue of inhibition of platelet hemostatic function, is withheld before many invasive procedures because of the bleeding risk. American Society of Gastrointestinal Endoscopy guidelines acknowledge the paucity of "high quality data" to make recommendations regarding the use of aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs) before endoscopic procedures. Yet the majority of endoscopists hold ASA/NSAIDs before polypectomy.
This single-center, retrospective, cohort study was conducted at Veterans Affairs Medical Center, Syracuse, NY. The objectives were to assess the postpolypectomy bleeding risk in ASA/NSAID users in a large cohort of veterans undergoing colonoscopic polypectomy and to identify risk factors associated with postpolypectomy bleeding. All patients undergoing polypectomy between January 2002 and October 2007 were eligible. Patients on anticoagulants/other antiplatelet agents were excluded. Patients were selected randomly by cluster sampling techniques. Electronic medical and pharmacy records were reviewed for patient demographics, polypectomy techniques, and postpolypectomy bleeding rates. Univariate analysis was performed between patients on ASA and NSAIDs (group A) versus those not on ASA or NSAIDs (group B). Multiple regression analysis was performed to identify independent risk factors associated with postpolypectomy bleeding.
Five hundred two (43%) of 1174 patients (mean age 66 years, 92% white) were on ASA or NSAIDs, or both. There was no significant difference between postpolypectomy bleeding rates among the 2 groups (3.2% vs 3.0%). Age, sex, polyp characteristics, and polypectomy techniques were comparable between groups A and B. In multiple logistic regression analysis, ASA or NSAID use was not a significant risk factor for postpolypectomy bleeding. Number of polyps removed per patient was the only risk factor significantly associated with postpolypectomy bleeding (P <.01, odds ratio 1.3, 95% confidence interval, 1.18-1.43).
In this large study, use of ASA or NSAIDs did not increase the risk of postpolypectomy bleeding. Cessation of ASA/NSAIDs before colonoscopy/polypectomy is therefore unnecessary.
由于出血风险，许多介入性操作前会停用阿司匹林（aspirin），因其可抑制血小板止血功能。美国胃肠内镜学会（American Society of Gastrointestinal Endoscopy）指南承认，针对内镜操作前应用阿司匹林（ASA）和非甾体抗炎药（NSAIDs），“高质量数据”有限，因此无法提出相关推荐意见。然而，大多数内镜医生在进行息肉切除术之前会停服 ASA/NSAIDs。
本单中心、回顾性队列研究在纽约州锡拉丘兹退伍军人事务医疗中心（Veterans Affairs Medical Center）开展。目的在于评估大量接受结肠镜息肉切除术的退伍军人中，ASA/NSAIDs 使用者的息肉切除术后出血风险，并确定与息肉切除术后出血相关的危险因素。2002 年 1 月至 2007 年 10 月期间所有接受息肉切除术的患者均符合入选条件。排除使用抗凝剂/其他抗血小板药物的患者。采用聚类抽样技术随机选择患者。电子病历和药房记录用于记录患者人口统计学特征、息肉切除术技术和息肉切除术后出血率。对 ASA 和 NSAIDs 使用者（A 组）与未使用 ASA 或 NSAIDs 者（B 组）进行单变量分析。采用多元回归分析确定与息肉切除术后出血相关的独立危险因素。
1174 例患者中 502 例（43%）接受了 ASA 或 NSAIDs 治疗或同时接受了这两种药物治疗（平均年龄 66 岁，92%为白人）。两组间息肉切除术后出血率无显著差异（3.2%比 3.0%）。A 组和 B 组间患者的年龄、性别、息肉特征和息肉切除术技术无显著差异。多元逻辑回归分析显示，ASA 或 NSAIDs 应用不是息肉切除术后出血的显著危险因素。每位患者切除的息肉数量是与息肉切除术后出血显著相关的唯一危险因素（P<.01，比值比 1.3，95%置信区间，1.18-1.43）。
在这项大型研究中，ASA 或 NSAIDs 的应用并未增加息肉切除术后出血的风险。因此，在结肠镜检查/息肉切除术前无需停用 ASA/NSAIDs。
